End-of-life Treatment Decisions and Patients’ Advance Directives
In a study using hypothetical cases, physicians commonly made end-of-life treatment decisions that were not consistent with patient preferences stated in explicit advance directives, according to an article in the July 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.
According to background information in the article, significant concern remains about how well physicians know and follow the treatment preferences of their patients. Decisions are particularly problematic for critically ill and dying patients who lose their capacity to make medical decisions. A variety of factors may influence treatment decisions – including the probability of survival or recovery, and perceived quality of life. While advance directives have been widely promoted as a means to ensure that patients’ treatment preferences are followed, there is limited evidence that they actually accomplish this purpose.
Steven B. Hardin, M.D., and colleagues with the Jerry L. Pettis Memorial Veterans Affairs Medical Center and Loma Linda University School of Medicine, Loma Linda, Calif., devised a survey of six hypothetical cases describing patients with serious or life-threatening illnesses who had lost their decision-making capacity. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. The study participants were all internal medicine faculty and resident physicians from Loma Linda University Medical Center and affiliated hospitals.
Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Of the 250 surveys mailed, 117 analyzable surveys were returned from 77 faculty and 40 resident physicians.
“Despite the presence of an explicit advance directive, physicians frequently made treatment decisions contrary to documented patient preferences,” the authors report.
In 65 percent of cases, decisions by faculty and residents were not consistent with the advance directive. This inconsistency was similar for faculty (68 percent of cases) and residents (61 percent of cases). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions.
“In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive,” the authors write.
The authors point out that advance directives have helped to encourage physicians and patients to start conversing about treatment decisions. But they assert that the limitation of advance directives illustrates the need for more effective conflict resolution when patients, family, and staff disagree about treatment choices.
“Continuing improvement in the process of end-of-life decision making is needed,” the authors conclude. “This process will have to recognize the inherent uncertainties in caring for seriously ill patients.”
The most recent press releases about innovation >>>
Die letzten 5 Focus-News des innovations-reports im Überblick:
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.
"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...
COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.
In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...
'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.
Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...